Essential Health Benefit Bill Clears Committee
Bill Monning, chair of the Assembly Committee on Health, knew the moment was a big one.
“We are serving as policymakers in extraordinary times,” Monning (D-Carmel) said yesterday at the health committee hearing. “For up to 5 million Californians, we have the opportunity before us to set essential health benefits.”
Monning introduced AB 1453, which laid out a plan for what essential benefits will be covered in California under the Affordable Care Act. The proposed set of benefits is modeled on the Kaiser small group HMO plan.
The Department of Health Care Services may need an abacus to keep track of all of the lawsuits being levied against it.
A ruling is expected as early as today in a lawsuit brought against DHCS by the California Primary Care Association and several other providers.
The CPCA hopes a federal judge will grant a temporary restraining order to halt a lower reimbursement rate for adult day health services in the recently launched Community Based Adult Services program.
Medi-Cal Cuts Face Another Preliminary Injunction
The Department of Health Care Services has been on the losing end so far of four court cases over the 10% cut in Medi-Cal provider rates. In each of the four cases, preliminary injunctions were granted to halt the cuts from specific provider groups, such as emergency transport, hospitals, pharmacies, physicians and dentists.
Now it’s adult day service providers’ turn for a judicial ruling.
A decision is expected today from federal judge Christina Snyder on a request for another preliminary injunction. This one is from adult day health providers who worked under the Adult Day Health Care program before it was terminated and replaced by the Community Based Adult Services program, or CBAS.
Food Distribution Inequity a Target of Talks
Paula Daniels is the senior advisor on food policy in Los Angeles County, but a lot of people don’t really understand what she’s working on.
“People don’t always get it,” Daniels said. “There’s an enormous amount of policy that’s related to the food system. When you think about the whole system, the kind of food, how it’s grown, how you get it, where it’s distributed, there’s regulatory policy, there’s economic policy. And from an environmental justice point of view, it cuts across every line.”
Daniels spoke yesterday in Los Angeles at an event called “An Appetite for Equity: Ensuring Access to Healthy Foods.” It’s the first of three meetings across the state sponsored by the California Pan-Ethnic Health Network. The next event is Apr. 11 in Fresno; the final one is Apr. 19 in Oakland.
State Names Four Counties for Duals Project
California took a big step yesterday, officially unveiling the four counties that will kick off the three-year project to eventually shift 1.1 million dual eligibles — Californians eligible for both Medi-Cal and Medicare — to a Medi-Cal managed care program.
The first four participants in the Coordinated Care Initiative are Los Angeles, Orange, San Diego and San Mateo counties. The Department of Health Care Services currently has authority to start the program in those counties, but legislation is pending in Sacramento that would expand authority for the number of participating counties — up to 10 of them by 2013.
The trailer bill language for that legislation has been finalized. The trailer bill is expected to be included in the budget package in June, DHCS officials said.
Tulare County Hospitals Want to Form LIHP
Senate member Jean Fuller (R-Bakersfield) is not interested in leaving federal health care dollars on the table.
That’s why she introduced a bill last week in the Senate Committee on Health that would enable local hospital districts in Tulare County to gain access to about $4.5 million in federal money over the next 18 months for a local Low Income Health Program (LIHP).
“Under current law, the county’s non-participation [in LIHP] precludes hospitals from leveraging the federal dollars that are available under the Medicaid waiver,” Fuller said last week in a Senate health hearing. “We can improve health care access with this, particularly in rural areas.”
New Adult Program Launches With a Few Issues Still To Be Resolved
It was January 2011 when the governor first red-lined the Adult Day Health Care program for elimination as a Medi-Cal benefit. Since then, it has been rescued, cut in half, eliminated altogether, reinstated and replaced.
Yesterday the replacement program, Community Based Adult Services, went into effect. For about 32,000 former beneficiaries of ADHC, the changeover will go relatively unnoticed. Most of the currently open centers are expected to remain open, and CBAS benefits are similar to those in the now extinct ADHC program.
“It’s a culmination of months of hard work, developing a program that’s appropriate and useful for former ADHC participants,” Norman Williams of the Department of Health Care Services said. “We had a goal of a program that would allow people to remain independent and living in the community.”
The CBAS era has officially begun.
Late Friday night, CMS approved implementation of the Community Based Adult Services program. That means the state has successfully eliminated adult day health care as a Medi-Cal benefit, and is replacing it with CBAS, starting today.
According to officials from the Department of Health Care Services, almost 32,000 of the nearly 40,000 ADHC beneficiaries have been deemed eligible for CBAS. That’s more than 80% of the ADHC population.
State: DHCS Contempt Motion Won’t Delay New Program Launch
Attorneys gathered in U.S. District Court yesterday morning to argue whether or not the state Department of Health Care Services should be found in contempt of court for its handling of the adult day health transition.
That argument will wait a week, at least. After meeting two hours yesterday, the two sides agreed to delay court proceedings.
“At this point the parties have been working on a possible solution. We hope to have a decision by next Friday,” Disability Rights California attorney Elissa Gershon told the federal magistrate hearing the case.
Ironing Out Details of Duals Conversion
State officials met with stakeholders in Sacramento yesterday to answer questions and work out the final details of the duals demonstration project — an ambitious plan to enroll an estimated 700,000 dual-eligible Californians in 10 counties into Medi-Cal managed care.
Enrollment will be mandatory for beneficiaries eligible for both Medi-Cal and Medicare. Jane Ogle, deputy director of health care delivery systems at the Department of Health Care Services, was quick to point out that beneficiaries would keep their own physician, even if that physician is not in the Medi-Cal network, and that beneficiaries have the power to opt out of the demonstration project, if they want.
“There is no need to assign a new doctor to people,” Ogle said. “There just is no need to do that.”